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Article Dans Une Revue Journal of Pediatric Surgery Année : 2022

Anti-reflux surgery in children with congenital diaphragmatic hernia: A prospective cohort study on a controversial practice

Louise Montalva
  • Fonction : Auteur
Elisabeth Carricaburu
  • Fonction : Auteur
Rony Sfeir
  • Fonction : Auteur
Virginie Fouquet
  • Fonction : Auteur
Naziha Khen-Dunlop
  • Fonction : Auteur
Frederic Hameury
  • Fonction : Auteur
Nicoleta Panait
  • Fonction : Auteur
Alexis Arnaud
  • Fonction : Auteur
Hubert Lardy
  • Fonction : Auteur
Françoise Schmitt
  • Fonction : Auteur
Christian Piolat
  • Fonction : Auteur
Frederic Lavrand
  • Fonction : Auteur
Quentin Ballouhey
  • Fonction : Auteur
Aurélien Scalabre
  • Fonction : Auteur
Erik Hervieux
  • Fonction : Auteur
Jean-Luc Michel
  • Fonction : Auteur
Isabelle Germouty
  • Fonction : Auteur
Philippe Buisson
  • Fonction : Auteur
Frederic Elbaz
  • Fonction : Auteur
Jean-Francois Lecompte
  • Fonction : Auteur
Thierry Petit
  • Fonction : Auteur
Audrey Guinot
  • Fonction : Auteur
Olivier Abbo
  • Fonction : Auteur
Emmanuel Sapin
  • Fonction : Auteur
François Becmeur
  • Fonction : Auteur
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Dominique Forgues
  • Fonction : Auteur
Maguelonne Pons
  • Fonction : Auteur
Arnaud Fotso Kamdem
  • Fonction : Auteur
Nicolas Berte
  • Fonction : Auteur
Marie Auger-Hunault
  • Fonction : Auteur
Alexandra Benachi
  • Fonction : Auteur
Arnaud Bonnard
  • Fonction : Auteur

Résumé

Introduction: Gastro-esophageal reflux disease (GERD) is the most frequent long-term morbidity of congenital diaphragmatic hernia (CDH) survivors. Performing a preventive fundoplication during CDH repair remains controversial. This study aimed to: (1) Analyze the variability in practices regarding preventive fundoplication; (2) Identify predictive factors for fundoplication. (3) Evaluate the impact of preventive fundoplication on gastro-intestinal outcomes in children with a CDH patch repair; METHODS: This prospective multi-institutional cohort study (French CDH Registry) included CDH neonates born in France between January 1st, 2010-December 31st, 2018. Patch CDH was defined as need for synthetic patch or muscle flap repair. Main outcome measures included need for curative fundoplication, tube feed supplementation, failure to thrive, and oral aversion. Results: Of 762 CDH neonates included, 81 underwent fundoplication (10.6%), either preventive or curative. Median follow-up was 3.0 years (IQR: 1.0-5.0). (1) Preventive fundoplication is considered in only 31% of centers. The rates of both curative fundoplication (9% vs 3%, p = 0.01) and overall fundoplication (20% vs 3%, p < 0.0001) are higher in centers that perform preventive fundoplication compared to those that do not. (2) Predictive factors for preventive fundoplication were: prenatal diagnosis (p = 0.006), intra-thoracic liver (p = 0.005), fetal tracheal occlusion (p = 0.002), CDH-grade C-D (p < 0.0001), patch repair (p < 0.0001). After CDH repair, 8% (n = 51) required curative fundoplication (median age: 101 days), for which a patch repair was the only independent predictive factors identified upon multivariate analysis. (3) In neonates with patch CDH, preventive fundoplication did not decrease the need for curative fundoplication (15% vs 11%, p = 0.53), and was associated with higher rates of failure to thrive (discharge: 81% vs 51%, p = 0.03; 6-months: 81% vs 45%, p = 0.008), tube feeds (6-months: 50% vs 21%, p = 0.02; 2-years: 65% vs 26%, p = 0.004), and oral aversion (6-months: 67% vs 37%, p = 0.02; 1-year: 71% vs 40%, p = 0.03). Conclusions: Children undergoing a CDH patch repair are at high risk of requiring a curative fundoplication. However, preventive fundoplication during a patch repair does not decrease the need for curative fundoplication and is associated with worse gastro-intestinal outcomes in children.
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Dates et versions

hal-03783155 , version 1 (21-09-2022)

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Louise Montalva, Elisabeth Carricaburu, Rony Sfeir, Virginie Fouquet, Naziha Khen-Dunlop, et al.. Anti-reflux surgery in children with congenital diaphragmatic hernia: A prospective cohort study on a controversial practice. Journal of Pediatric Surgery, 2022, ⟨10.1016/j.jpedsurg.2022.04.017⟩. ⟨hal-03783155⟩
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